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Yao L, Subramaniam K, Raja KM, Arunachalam A, Tran A, Pandey T, Ravishankar S, Suggala S, Hendrickson C, Maxwell AJ. Association of postural orthostatic tachycardia syndrome, hypermobility spectrum disorders, and mast cell activation syndrome in young patients; prevalence, overlap and response to therapy depends on the definition. Front Neurol 2025; 16:1513199. [PMID: 40352770 PMCID: PMC12063504 DOI: 10.3389/fneur.2025.1513199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 03/10/2025] [Indexed: 05/14/2025] Open
Abstract
Background The close association of syndromes of orthostatic intolerance with and without postural orthostatic tachycardia syndrome (POTS) with Joint Hypermobility Disorders (JHD) including Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers Danlos Syndrome (hEDS) and with Mast Cell Activation Syndrome (MCAS) is now firmly established. However, the prevalence of each entity relative to the other is not well established and is affected greatly by the various definitions used for each syndrome. Use of restricting definitions for each syndrome can be problematic in the clinical setting as it under-estimates the presence of disease, thereby preventing clinicians from considering potentially helpful therapeutic options. Methods A retrospective review of the clinical records of 100 young patients meeting POTS criteria was undertaken to determine the frequency of HSD, near-hEDS, and hEDS as well as the frequency of MCAS using consensus-1, conservative consensus-2, and clinical criteria regardless of lab support. Effectiveness of MCAS therapies was assessed in relation to the method of MCAS diagnosis. Results From records of 392 patients with orthostatic intolerance syndromes, 100 patients met POTS criteria. The frequency of JHD ranged from 13% using strict criteria of hEDS to 34% using HSD Criteria. The frequency of MCAS ranged from 2% using consensus-1 criteria, to 37% using conservative consensus-2 criteria, to 87% using clinical criteria. Patients diagnosed by clinical criteria with or without the aid of labs responded to therapy similarly to those diagnosed with stricter criteria. Conclusion Using overly strict criteria to diagnose conditions which have a high prevalence of co-occurrence misses opportunities for potential therapeutic strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andrew J. Maxwell
- Heart of the Valley Pediatric Cardiology, Pleasanton, CA, United States
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Palmer RF, Kattari D, Verduzco-Gutierrez M. Effects of the COVID-19 pandemic on individuals with chemical intolerance. Fam Med Community Health 2025; 13:e003081. [PMID: 40280594 PMCID: PMC12035467 DOI: 10.1136/fmch-2024-003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
OBJECTIVE The purpose of this study was to determine if the COVID-19 pandemic had differential effects on individuals with chemical intolerances (CI). CI is characterised by multisystem symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxins including chemicals, foods and drugs. With an estimated 20% US prevalence, symptoms include fatigue, headache, weakness, rash, mood changes, musculoskeletal pain, gastrointestinal issues, difficulties with memory, concentration and respiratory problems, which are similar to COVID-19 and its sequelae. DESIGN A US population-based survey involving 7500 respondents was asked if they ever had COVID-19, what the severity was, and if they had long COVID-19. CI was assessed using the Quick Environmental Exposure and Sensitivity Inventory. SETTING The Center for Disease Control estimates that over 24 million have been infected with COVID-19 in the USA with over 6 700 000 being hospitalised and over 1 174 000 deaths. Other industrialised countries show similar numbers. RESULTS Those in the High CI class reported a greater COVID-19 prevalence, symptom severity and long COVID-19 than in the medium and low CI groups (p<0.0001). These associations were independent of race, ethnicity, income, age and sex. However, there were significantly increased odds of COVID-19 severity among women and those over 45 years old. Asian individuals were least likely to have severe symptoms compared with white individuals (OR=0.53; 95% CI 0.35 to 0.79). Black/African American individuals reported a lower prevalence of COVID-19 than non-Hispanic whites. However, one interaction between CI and race was significant, African Americans with high CI reported greater odds (OR=2.2; 95% CI 1.15 to 3.16) of reporting COVID-19 prevalence. Furthermore, African American individuals had significantly greater odds of increased symptom severity. CONCLUSION Prior studies show higher risk for COVID-19 among older age groups, male sex, those with pre-existing comorbidities (eg, challenged immunities) and those from minoritised racial/ethnic groups. The results of this study suggest that those with CI be included in a high-risk group. Various risk subsets may exist and future investigations could identify different risk subsets. Understanding these subgroups would be helpful in mounting targeted prevention efforts.
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Affiliation(s)
- Raymond F Palmer
- Family and Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Duque-Wilckens N, Joseph D, Syed M, Smith B, Maradiaga N, Yeh SY, Srinivasan V, Sotomayor F, Durga K, Nestler E, Moesers AJ, Robison AJ. FosB/ΔFosB activation in mast cells regulates gene expression to modulate allergic inflammation in male mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2025:2024.05.06.592755. [PMID: 38766119 PMCID: PMC11100602 DOI: 10.1101/2024.05.06.592755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Mast cells are innate immune cells that regulate physiological processes by releasing pre-stored and newly synthesized mediators in response to allergens, infection, and other stimuli. Dysregulated mast cell activity can lead to multisystemic pathologies, but the underlying regulatory mechanisms remain poorly understood. We found that FOSB and ΔFOSB, transcription factors encoded by the FosB gene, are robustly expressed in mast cells following IgE-antigen stimulation, suggesting a role in modulating stimulus-induced mast cell functions. Using phenotypic, gene binding, and gene expression analyses in wild-type and mast cell-specific FosB knockout male mice, we demonstrate that FOSB/ΔFOSB modulates mast cell functions by limiting reactivity to allergen-like stimuli both in vitro and in vivo . These effects seem to be mediated, at least in part, by FOSB/ΔFOSB-driven enhanced expression of DUSP4, a dual-specificity phosphatase that attenuates MAPK signaling. These findings highlight FOSB/ΔFOSB as critical regulators of mast cell activity and potential targets for therapeutic intervention.
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Rincón R, Perales R, Palmer RF, Forster JF, Hernandez JF, Bayles B, Grimes C, Jaén CR, Miller CS. Environmental house calls can reduce symptoms of chemical intolerance: a demonstration of personalized exposure medicine. Prim Health Care Res Dev 2024; 25:e53. [PMID: 39434594 PMCID: PMC11569860 DOI: 10.1017/s146342362400046x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/30/2024] [Accepted: 08/01/2024] [Indexed: 10/23/2024] Open
Abstract
AIM The goals of this investigation were to 1) identify and measure exposures inside homes of individuals with chemical intolerance (CI), 2) provide guidance for reducing these exposures, and 3) determine whether our environmental house calls (EHCs) intervention could reduce both symptoms and measured levels of indoor air contaminants. BACKGROUND CI is an international public health and clinical concern, but few resources are available to address patients' often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two to five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products, are symptom triggers commonly reported by susceptible individuals. METHODS A team of professionals trained and led by a physician/industrial hygienist and a certified indoor air quality specialist conducted a series of 5 structured EHCs in 37 homes of patients reporting CI. RESULTS We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the Quick Environmental Exposure and Sensitivity Inventory Symptom Star, corresponded with the reduction of indoor air volatile organic compounds, most notably fragrances. These results provide a deeper dive into 3 of the 37 cases described previously in Perales et al. (2022). DISCUSSION We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems' 'first responders', mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use have grown exponentially since World War II. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (often referred to as 'brain fog'). The time has come to translate these research findings into clinical and public health practice.
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Affiliation(s)
- Rodolfo Rincón
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Roger Perales
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Jackie F. Forster
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Jessica F. Hernandez
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Bryan Bayles
- Department of Life Sciences, Texas A&M University-San Antonio, San Antonio, TX, USA
| | | | - Carlos R. Jaén
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Claudia S. Miller
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Kinsella L, Brook J, Briest M, Brook MJ. Inconsistent excipient listings in DailyMed: implications for drug safety. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:6851-6854. [PMID: 38563879 DOI: 10.1007/s00210-024-03067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
Excipients, or inactive ingredients, are a frequent cause of medication intolerance and allergy. Patients and clinicians concerned about medication allergies and sensitivities rely on the U.S. National Library of Medicine's DailyMed for accurate lists of excipients. Based on our anecdotal discovery of several examples of excipient omissions, we wished to examine the accuracy of DailyMed's listings more systematically in a sample of commonly prescribed medications. The objective of the study is to identify the frequency of inconsistency of excipient reporting within the DailyMed website. We performed a database audit of the Structured Product Labeling XML file provided by the drug manufacturer to the Food and Drug Administration and DailyMed for two randomly selected formulations of each of 50 commonly prescribed medications. For each of the 100 formulations, we compared the excipients listed in the "Description" to those in the "Ingredients and Appearance" sections in DailyMed. The Structured Product Labeling data file provided by the drug manufacturer contained internal inconsistencies of excipients in 39% of the formulations examined. Despite the use of Structured Product Labeling, the drug manufacturer's medication labels provided to the FDA and reported by DailyMed often contain conflicting information about inactive ingredients. Patients with allergies and excipient sensitivity should be aware of these discrepancies and consult multiple sections of the label to identify potential allergy-inducing inactive ingredients.
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Affiliation(s)
| | - Jill Brook
- Standing Up to POTS, Springfield, OH, USA.
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Reis J, Spencer PS. An introduction to environmental neurotoxicology: Lessons from a clinical perspective. J Neurol Sci 2024; 463:123108. [PMID: 38991324 DOI: 10.1016/j.jns.2024.123108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
In 1992, the Committee on Neurotoxicology and Models for Assessing Risk of the National Academy of Sciences in Washington DC focused with a scientific perspective on the identification of substances with neurotoxic potential, studies of exposed populations, risk assessment, and biologic markers of disease. This Committee recommended: "all physicians should be trained to take a thorough occupational-exposure history and to be aware of other possible sources of toxic exposure". Although convened after several outbreaks of neurotoxic syndromes, clinical neurological considerations were lacking. After defining keys words, namely Environment, Neurotoxicology and Neurotoxicants, we present some demonstrative cases; e.g., the Epidemic Neuropathy in Cuba, Minamata disease, ALS/PDC on Guam, and the ALS hot spot in the French Alps. Always with a clinical and practical approach, we will then review the milieux that contain and convey potential neurotoxicants, the different exposure routes and the clinical presentations. Drawing lessons from clinical cases, we offer some thoughts concerning the future of Environmental Neurotoxicology (ENT). Pointing notably to the diffuse chemical contamination of ecosystems and living beings, including Homo sapiens, we question the real impact of agents with neurotoxic potential on the human brain, considering the effects, for example, of air pollution, endocrine disruptors and nanoparticles. Concern is expressed over the lack of knowledge of the non-monotonic kinetics of many of these chemicals, the major concern being related to mixtures and low-dose exposures, as well as the delayed appearance in clinical expression of prevalent neurodegenerative diseases.
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Affiliation(s)
- J Reis
- Department of Neurology, University Hospital of Strasbourg, 67000 Strasbourg, France; Association RISE, 67205 Oberhausbergen, France.
| | - P S Spencer
- Department of Neurology, School of Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA
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Weinstock LB, Tenkhoff M, Gutovich J, Afrin LB. Imatinib and Trigger Avoidance for Mast Cell Activation Syndrome Presenting With Attacks of Abdominal Pain, Nausea, Vomiting, and Diarrhea. ACG Case Rep J 2024; 11:e01383. [PMID: 38883580 PMCID: PMC11177828 DOI: 10.14309/crj.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
The etiology for concurrent attacks of abdominal pain, nausea, vomiting, and diarrhea can be obscure. Mast cell activation syndrome is not usually considered in this differential diagnosis. A 53-year-old paint salesman suffered severe attacks of these symptoms for the 3 decades of his career. Nortriptyline, loperamide, hyoscyamine, and ondansetron failed to address his symptoms. Mast cell activation syndrome was ultimately diagnosed. Intravenous mast cell-targeted therapy reduced severity of attacks. Multiple oral mast cell-targeted treatments were ineffective, but addition of low-dose imatinib resulted in dramatic improvement. Recognition that paint-fume exposure-triggered attacks led to behavioral modifications which further reduced symptoms.
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Affiliation(s)
- Leonard B Weinstock
- Gastroenterology Department, Specialists in Gastroenterology, GI Alliance, St. Louis, MO
| | - Megan Tenkhoff
- Department of Pharmacy, Pharmacy School, Southern Illinois University Edwardsville, Edwardsville, IL
| | | | - Lawrence B Afrin
- Department of Mast Cell Studies, Hematology/Oncology, AIM Center for Personalized Medicine, Purchase, NY
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Nagy ÈS, Westaway M, Danieletto S, Afrin LB. Breast Implant Illness May Be Rooted in Mast Cell Activation: A Case-Controlled Retrospective Analysis. ANNALS OF SURGERY OPEN 2024; 5:e398. [PMID: 38883946 PMCID: PMC11175949 DOI: 10.1097/as9.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To investigate the possible association between breast implant illness (BII) and mast cell activation syndrome (MCAS), which often manifests increased mast cells (MCs) in assorted tissues and may explain BII symptoms. Background Mechanisms by which implants cause BII symptoms remain unclear, but BII and MCAS symptom profiles heavily overlap, warranting investigation of potential linkage. Methods We retrospectively analyzed 20 implant patients who underwent explantation and total capsulectomy; 15 self-reported preoperatively they had BII (subject group); 5 felt they did not [control group 1 (CG1)]. Five prophylactic mastectomy patients constituted control group 2 (CG2). Subjects and CG1 patients completed BII symptom questionnaires preoperatively and multiple points postoperatively. With CD117 staining, average and maximum mast cell counts (MCCs) in resected tissues were determined. Results Mean BII symptom score 2 weeks postexplantation was reduced by 77% (P < 0.0001), and 85% by 9 months. Analysis suggested BII in CG1 patients, too, who improved similarly. Among CG2 patients, healthy breast tissue showed mean and maximum MCCs of 5.0/hpf and 6.9/hpf. Mean and maximum MCCs in capsules in BII patients were 11.7/hpf and 16.3/hpf, and 7.6/hpf and 13.3/hpf in CG1 patients. All intergroup comparisons were significantly different (P < 0.0001). Conclusions MCCs in peri-implant capsules in BII patients are increased; some implanted patients appear to have unrecognized BII. Given that neoantigenic/xenobiotic exposures commonly trigger dysfunctional MCs in MCAS to heighten aberrant mediator expression driving inflammatory and other issues, further investigation of whether BII represents an implant-driven escalation of preexisting MCAS and whether an MCAS diagnosis flags risk for BII seems warranted.
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Affiliation(s)
- Èva S Nagy
- From the Sydney Oncoplastic Surgery, North Shore Health Hub, St Leonards, NSW, Australia
| | | | - Suzanne Danieletto
- Douglas Hanly Moir, Macquarie University Hospital, Macquarie Park, NSW, Australia
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Tetley A. Do no harm: Multiple chemical sensitivity is not psychological. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:266-267. [PMID: 38185499 DOI: 10.1016/j.jaip.2023.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024]
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Palmer RF, Dempsey TT, Afrin LB. Chemical Intolerance and Mast Cell Activation: A Suspicious Synchronicity. J Xenobiot 2023; 13:704-718. [PMID: 37987446 PMCID: PMC10660865 DOI: 10.3390/jox13040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/19/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
Background: Chemical Intolerance (CI) is characterized by intolerances for chemicals, foods, and drugs with multi-system symptoms. As yet, the biomechanism remains unclear. One study reported converging lines of evidence supporting a substantive association between mast cell activation syndrome (MCAS) and CI. The purpose of this study is to (1) confirm a previous report demonstrating that 60% of MCAS patients report CI and (2) examine the parallels between symptoms and intolerances in CI and MCAS. Methods: Five hundred forty-four MCAS patients were assigned a clinical MCAS score using a validated assessment instrument and were assessed for CI using the validated Quick Environmental Exposure Sensitivity Index. Results: Our outcomes confirm the previously published study where the majority of MCAS patients also have CI. There was a clear overlap between various ICD-10 diagnostic categories and CI symptoms, providing further support for a potential shared mechanism. Conclusions: Exposures to pesticides, volatile organic compounds, combustion products, and mold have previously been reported as initiators of CI. However, until recently, little was known about the biological mechanism involved that could explain the multisystem symptoms associated with CI. This paper addresses a newly identified biomechanism for disease, which may underlie a host of "medically unexplained symptoms" triggered by xenobiotics.
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Affiliation(s)
- Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA
| | - Tania T Dempsey
- AIM Center for Personalized Medicine, Purchase, NY 10577, USA
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Molot J, Sears M, Anisman H. Multiple Chemical Sensitivity: It's time to catch up to the science. Neurosci Biobehav Rev 2023; 151:105227. [PMID: 37172924 DOI: 10.1016/j.neubiorev.2023.105227] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Margaret Sears
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Hymie Anisman
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
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Exploring the mechanism of sweetener neohesperidin dihydrochalcone on oral tolerance via a network pharmacology approach combined with vivo and vitro methods. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Connecting the Dots in Emerging Mast Cell Research: Do Factors Affecting Mast Cell Activation Provide a Missing Link between Adverse COVID-19 Outcomes and the Social Determinants of Health? Med Sci (Basel) 2022; 10:medsci10020029. [PMID: 35736349 PMCID: PMC9228930 DOI: 10.3390/medsci10020029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023] Open
Abstract
Evidence continues to emerge that the social determinants of health play a role in adverse outcomes related to COVID-19, including increased morbidity and mortality, increased risk of long COVID, and vaccine adverse effects. Therefore, a more nuanced understanding of the biochemical and cellular pathways of illnesses commonly associated with adverse social determinants of health is urgently needed. We contend that a commitment to understanding adverse outcomes in historically marginalized communities will increase community-level confidence in public health measures. Here, we synthesize emerging literature on mast cell disease, and the role of mast cells in chronic illness, alongside emerging research on mechanisms of COVID illness and vaccines. We propose that a focus on aberrant and/or hyperactive mast cell behavior associated with chronic underlying health conditions can elucidate adverse COVID-related outcomes and contribute to the pandemic recovery. Standards of care for mast cell activation syndrome (MCAS), as well as clinical reviews, experimental research, and case reports, suggest that effective and cost-efficient remedies are available, including antihistamines, vitamin C, and quercetin, among others. Primary care physicians, specialists, and public health workers should consider new and emerging evidence from the biomedical literature in tackling COVID-19. Specialists and researchers note that MCAS is likely grossly under-diagnosed; therefore, public health agencies and policy makers should urgently attend to community-based experiences of adverse COVID outcomes. It is essential that we extract and examine experiential evidence of marginalized communities from the broader political–ideological discourse.
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Palmer R, Walker T, Perales R, Rincon R, Jaén C, Miller C. Disease comorbidities associated with chemical intolerance. ENVIRONMENTAL DISEASE 2021. [DOI: 10.4103/ed.ed_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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